血清甲胎蛋白和CA19-9对混合型肝癌根治术预后的影响  

Influence of serum alpha-fetoprotein and CA19-9 on the prognosis of patients with combined hepatocellular-cholangiocarcinoma after radical surgery

作　　者：张鸿渐 段小辉[2] 张恒 徐阳建培 卿宇豪 王子承 毛先海 Zhang Hongjian;Duan Xiaohui;Zhang Heng;Xuyang Jianpei;Qing Yuhao;Wang Zicheng;Mao Xianhai(Department of Hepatobiliary Surgery,Shaoyang Central Hospital(Shaoyang Hospital Affiliated to Nanhua University),Shaoyang 422000,China;Department of Hepatobiliary Surgery,Hunan Provincial People's Hospital(the First Affiliated Hospital of Hunan Normal University),Changsha 410000,China;Department of Hepatobiliary Surgery,Hunan Cancer Hospital(Xiangya Medical College Affiliated Cancer Hospital of Central South University),Changsha 410000,China)

机构地区：[1]邵阳市中心医院(南华大学附属邵阳医院)肝胆外科,邵阳422000 [2]湖南省人民医院(湖南师范大学附属第一医院)肝胆外科,长沙410000 [3]湖南省肿瘤医院(中南大学湘雅医学院附属肿瘤医院)肝胆外科,长沙410000

出　　处：《中华肝胆外科杂志》2025年第2期87-91,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的分析血清甲胎蛋白和糖类抗原19-9(CA19-9)对混合型肝癌根治术预后的影响。方法回顾性分析2009年1月至2019年1月于湖南省人民医院接受根治性肿瘤切除的100例混合型肝癌患者的临床资料,其中男性73例,女性27例,年龄(52.0±10.9)岁。单因素以及多因素Cox回归分析甲胎蛋白、CA19-9对混合型肝癌患者术后无瘤生存的影响,同时进行亚组分析,分析不同水平的甲胎蛋白、CA19-9患者无瘤生存率差异。使用Kaplan-Meier法描绘生存曲线,log-rank检验比较组间的生存率差异。结果单因素分析显示行根治手术切除患者的甲胎蛋白、CA19-9、丙氨酸转氨酶、天冬氨酸转氨酶、美国癌症联合委员会(AJCC)肿瘤TNM分期、门静脉侵犯、肿瘤数量与患者术后无瘤生存相关(均P<0.05)。多因素Cox回归分析结果显示,甲胎蛋白≥20.6μg/L(HR=6.686,95%CI:1.985~9.582)、CA19-9≥35.2 U/L(HR=5.790,95%CI:1.197~8.855)、AJCC肿瘤TNM分期Ⅱ期(HR=6.384,95%CI:2.069~11.532)、门静脉侵犯(HR=2.384,95%CI:1.100~10.125)是混合型肝癌患者术后无瘤生存期短的危险因素(均P<0.05)。亚组分析结果显示,甲胎蛋白≥20.6μg/L且CA19-9≥35.2 U/L患者(n=14)的无瘤生存率低于甲胎蛋白<20.6μg/L且CA19-9≥35.2 U/L的患者(n=32)和甲胎蛋白≥20.6μg/L且CA19-9<35.2 U/L的患者(n=20),差异均具有统计学意义(χ^(2)=6.23、4.98,P=0.014、0.043)。结论甲胎蛋白≥20.6μg/L和CA19-9≥35.2 U/L是混合型肝癌患者术后无瘤生存期短的危险因素,甲胎蛋白≥20.6μg/L且CA19-9≥35.2 U/L的混合型肝癌患者预后更差。Objective To analyze the impact of serum alpha-fetoprotein(AFP)and carbohydrate antigen 19-9(CA19-9)on the prognosis of patients with combined hepatocellular-cholangiocarcinoma(CHC)after radical surgery.Methods Clinical data of 100 patients diagnosed with CHC by postoperative pathology in Hunan Provincial People's Hospital from January 2009 to January 2019 were retrospectively analyzed,including 73 males and 27 females,aged(52.0±10.9)years.Univariate and multivariate Cox regression analysis were conducted to try to find out the effects of AFP and CA19-9 on postoperative disease-free survival(DFS)of patients with CHC.Subgroup analysis was also performed to analyze the DFS among patients with different levels of AFP and CA19-9.Kaplan-Meier method and log-rank test were used to plot and compare the survival curves between groups.Results Univariate analysis showed that levels of AFP,CA19-9,alanine transaminase,aspartate transaminase,American Joint Committee on Cancer(AJCC)TNM staging,portal vein invasion,tumor number are associated with postoperative DFS in CHC patients(all P<0.05).The multivariate Cox analysis showed that AFP≥20.6μg/L(HR=6.686,95%CI:1.985-9.582),CA19-9≥35.2 U/L(HR=5.790,95%CI:1.197-8.855),AJCC tumor TNM staging stageⅡ(HR=6.384,95%CI:2.069-11.532),and portal vein invasion(HR=2.384,95%CI:1.100-10.125)were risk factors for a shortened DFS in CHC patients after surgery(all P<0.05).Subgroup analysis showed that patients with AFP≥20.6μg/L and CA19-9≥35.2 U/L(n=14)had a lower DFS compared to patients with AFP<20.6μg/L and CA19-9≥35.2 U/L(n=32),and patients with AFP≥20.6μg/L and CA19-9<35.2 U/L(n=20)(χ^(2)=6.23,4.98,P=0.014,0.043).Conclusion AFP and CA19-9 are risk factors for DFS in CHC patients.Patients with AFP≥20.6μg/L and CA19-9≥35.2 U/L showed a worse prognosis.

关 键 词：肝肿瘤 甲胎蛋白类 影响因素 预后 混合型肝癌 

分 类 号：R73[医药卫生—肿瘤]